Surgeons in demand

Medicare doesn't work that way and since most insurance companies base their rates on Medicare, they don't either.

Did you know you generally get paid LESS when you work in a rural area? For example, for CPT 19302 (partial mastectomy) the 2008 Medicare rate is around $885 in San Francisco. Its $760 in the non urban areas (ie, not SF, San Mateo, LA, etc.)

Obviously I'm not talking about salaries a hospital might lure you with to come work in a rural area, but from a strict "pay cut" POV, a rural PP will pay you less for your work than if you work in an urban area. Goes without saying though that the COL and practice is higher in the latter.

jubb said:

Here's an article in USA today about the shortage of surgeons that's coming up and how it's affecting rural areas the most. Hopefully the demand will stop the pay cuts. Read the comments by the people who can't spell if you wanna get pissed off. I love how they can't spell but yet they think they understand healthcare better than people who work in the field.

http://www.usatoday.com/news/health/2008-02-26-doctor-shortage_N.htm

Click to expand...

WS is very right. Private insurance companies watch CMS (Center for Medicaid & Medicare Services) and their reimbursement rates to determine how much they're going to pay-out to physicians.

Reimbursements are adjusted for geography, so unlike what you may have heard, physicians in urban areas with higher costs of living will get a slightly higher reimbursement. But of course the cost to operate a practice in these areas often times outpaces the adjustment CMS makes, so the end result is salaries in urban centers tend to be lower than in the middle of nowhere.

Anyway, reimbursements set by CMS vary not based on physician supply and demand. It's actually quite complex as I don't entirely understand it, but they're set based on utilization and projection of utilization for a particular service. Such that surgical services have been screwed left and right over the last few years. Radiological services have been screwed even more (that's why Rads guys aren't seeing as often the four month vacations and the crazy high salaries of just a few years before). Interestingly Anesthesia services recently went up, I believe.

So the bottomline? Surgeons failing in practice in rural areas is just a testament to the fact that even in the boonies, where cost of living is uber cheap, and malpractice is cheaper still, reimbursements just aren't high enough to support a surgical practice. It's sad. And people in these areas will die waiting or in transit to the nearest "big city" surgical facility. However this is what the lay public had wrought.

The fall in reimbursements for radiological procedures is very interesting.

I've been working on a project comparing all our insurance company rates so that come contract renegotiation time, they either pay up or we drop them. All of our contracts currently have been adjusted to 2007 Medicare rates (which are higher than 2008). I got an invite today from a local company that offered me 90% of 2008 Medicare rates - I explained that our minimum rate was 125% of 2007 Medicare rates and that they had to list us as the preferred providers for their employees and hospitals.

Anyway, while all surgical rates are lower this year than they were last year and the year before, rates for image guided procedures/radiological procedures are significantly down. For example:

stereotactic biopsy of the breast now pays around $300; it was over $1200 a couple of years ago. Technically, you make more than $300 or $1200 because that is just for the procedure, you also make money for interpreting the images, for placement of the marking clip, etc. but overall, a HUGE drop in reimbursement.

This is interesting to me because the rest of the stereotactic procedures have NOT decreased this much. And I suspect that this is because these are done by surgeons, whereas the stereotactic biopsy of the breast, which was (and still is) so jealously guarded by radiologists that the vast majority of academic breast fellowship trained surgeons do not know how to do the procedure, is done mostly by radiologists (and smart breast surgeons who finagle their way into a community which allows them to do so..then again, who cares, its only $300 now).

Granted the reimbursements for radiologists, like so many other specialties have risen for years, while surgery had declined every year and we have saddled ourselves with the global post-op period crap.

Winged Scapula said:

Granted the reimbursements for radiologists, like so many other specialties have risen for years, while surgery had declined every year and we have saddled ourselves with the global post-op period crap.

Click to expand...

90 Days.

Thank God for EVARs, TEVARs, and elephant trunks.

Winged Scapula said:

Did you know you generally get paid LESS when you work in a rural area? (partial mastectomy) is around $885 in San Francisco. Its $760 in the non urban areas. A rural PP will pay you less for your work than if you work in an urban area.

Click to expand...

What's the logic behind that policy?

Don't rural doctors usually have to deal with working in a hospital w/ less updated equipment to aid in making a diagnosis, less quality ancillary staff to assist during the procedures & post-op care, and are on call more often?

It seems like they should be paid at least equally.

Their malpractice tends to be lower than in urban areas.

A friend of mine is in PP General Surgery somewhere in Alabama and he pays just $30,000 a year in malpractice. Granted he's been out only two or three years, but that's damn low.

I read the article. I have been saying for years that there is going to be a major problem finding a surgeon in about 10 years when all the baby boomers retire. I love how USAtoday is writing about it like they discovered some major impending doom. Ha!

I also love how the most selfish and destructive generation in US history - baby boomers - is complaining that Gen X and Y don't want to work longer hours for less money. I know a boomer very very well who entered practice in 1979. His first year in practice he took home after taxes (yes I saw the tax return) $579,000. Back then you could buy a Porsche 911 Turbo for about $40,000. Now a general surgeon in the first year of practice would be doing cartwheels if he could take home $150,000. A similar Porsche today is ~$190K. For the math challenged, you could buy 14 911 turbos in 1979, and you can't buy 1 today. Why would I work the same or more hours for 1/14th the buying power? Get real.

And I almost forgot. We went to the same medical school. His tuition was $3500 a year, mine was $40,000. On top of that, he was allowed to defer his loans (they didn't accumulate interest) while he was in residency. His salary as a resident was ~$25K a year in the 1970's, which was enough to support a family. Mine was 34950 my intern year and a couple hundred dollars per year more after that. Hmmmm...... I'm the selfish lazy one here?

Castro Viejo said:

Their malpractice tends to be lower than in urban areas.

A friend of mine is in PP General Surgery somewhere in Alabama and he pays just $30,000 a year in malpractice. Granted he's been out only two or three years, but that's damn low.

Click to expand...

It also depends on the area of the country.

In the 5th largest city in the US (where I am), I will max out (at current rates) at $50,000 a year in malpractice. Obviously more than the $30K in Alabama but half of what my Pennsylvania colleagues pay.

Anyway, trying to figure out the rhyme or reason behind reimbursement is just impossible. Cost of doing business is more in urban areas, malpractice is higher (presumably a more educated and lawsuit happy population with higher expectations) and even the cost of supplies. Go to a Wendy's in a big city and see what the combo costs you; it will be more than in the small town. When I used to moonlight in PA and live in Jersey, I'd buy my groceries in PA because it was cheaper. I'm sure all of these things play into the reimbursement differential.

Wow. I had no idea Phoenix was that big. That's wild.

We're number #5! We're number 5!

911 turbo is closer to 120k.

basupran said:

911 turbo is closer to 120k.

Click to expand...

He was probably thinking of the GT2 ($191k).

There is no shortage of surgeons... just surgeons willing to work for garbage reimburisements.

The average hours of an attending? 65 per week?

25 hours overtime? that's like working half a second job (37.5 hrs a week). So effectively, if you are getting paid $220k a year, you are really working at the rate of someone making $110k a year cause you are spending a lot of hours doing that work.

Urban starting at $165k a year? WTF... and you wonder why no one would take it. Hospital expectations are getting too high. This is fine, Castro said it, the lay person needs to reap what the consequences. Obviously healthcare is not a priority enough during their elections (presidential and congressional).

jubb said:

I think it is going to put pressure on the hospitals to sweeten the deal for General surgeons who will cover the ER in remote areas. I know the per procedure reimbursement probably won't change, but the hospitals will tack some on for taking call, or even agreeing to work in a rural setting. I guess either that or the hospitals will have to shut down, cuz a hospital has a hard time being profitable without surgeons.

Click to expand...

Uh... A hospital also has a hard time being profitable without money.

Hospitals that are dying to have a surgeon take trauma call generally can't afford much to pay out to "sweeten the deal," unfortunately. Reimbursements to "providers" (read: physicians, surgeons, NPs, PAs, CRNAs, etc.) as well as facilities/institutions are falling.

Eventually the entire system will die.

That's why I'm one day going to go get an MBA.

Castro Viejo said:

Uh... A hospital also has a hard time being profitable without money.

Hospitals that are dying to have a surgeon take trauma call generally can't afford much to pay out to "sweeten the deal,".

Click to expand...

True. I worked in an 18 bed "hospital" in rural kansas for a year and a half. There is only ONE doctor in town, an FP "who does it all". They have been trying to recruite another doctor, specifically a surgeon for 5 years now, but no luck. The FP has a HUGE patient base (the whole freakin town!), and is doing very well, but works like a dog. They had a surgeon some years ago, but he did not stay too long...He was operating once in a blue moon (the FP did most of the common minor stuff for his patients), and was not worth the high malpractice premium he was paying.

I'm starting to believe that I should've listened to my old relative who is a retired surgeon who implored that I not go into medicine, let alone surgery. He must think I'm pretty stupid.

All of this is rather....depressing. I have visions of having about the same amount of spare change as I do now after I start on a surgeon's salary and the loan payments kick in. Grand.

I read the USAtoday article and it was interesting that the author primarily blamed the shortage of surgeons on miscalculations in the 1990s about how many surgeons we would need as a population. The fact that reimbursements fall in real dollars every year, and malpractice rates rise in real dollars every year, and operating costs rise did not figure into the story very much.

Almost 80% of general surgery chief residents are now seeking fellowship training. Essentially there may be only ~200 new general surgeons entering the workforce per year in the entire country. If the law of supply and demand was at work in the realm of medicine, then these men and women would be commanding million dollar salaries... Instead they are getting offers ranging from 150-250K to start in jobs where they might be on call q2. It's no wonder that fellowship training is so popular. This dynamic has nothing to do with predictions made in the 1990s... it has to do with quality of life, and economics of 2008.

I agree with Castro... the system is broken. And it doesn't matter if McCain, Billary, or Obama gets elected... the system is one big rambling wreck that is unfixable.

No. Stupid would be voting Democrat.

You and I were just two wide-eyed optimists who were born at the wrong time and have a gift to heal people.

I wanna make something perfectly clear..... Hospitals are NOT losing money when the surgeon's reimburisement is being cut.

Like it or not... surgeons have become hospital employees... you wanna leave to do surgery elsewhere? Fine go for it... we'll get someone else.. good luck finding a nearby center... and dont even try opening your own specialty surgery center... that's not allowed anymore and if you want someone else to open it, well you gotta get a certificate of need and guess what.. with this hospital around there is no need.


Building more surgi-centers is a good solution. Hospitals have a monopoly and you are forced to accept what they will hand down to you.

Celiac Plexus said:

I agree with Castro... the system is broken. And it doesn't matter if McCain, Billary, or Obama gets elected... the system is one big rambling wreck that is unfixable.

Click to expand...

I disagree with you on that. Billary will screw with us more than Obama, but Obama will screw with us more than McCain. In the end it'll be John Q. Public who screws us the most with his penchant for frivilous lawsuits.

Faebinder said:

I wanna make something perfectly clear..... Hospitals are NOT losing money when the surgeon's reimburisement is being cut.

Like it or not... surgeons have become hospital employees... you wanna leave to do surgery elsewhere? Fine go for it... we'll get someone else.. good luck finding a nearby center... and dont even try opening your own specialty surgery center... that's not allowed anymore and if you want someone else to open it, well you gotta get a certificate of need and guess what.. with this hospital around there is no need.

Click to expand...

Yes, hospitals aren't losing money as a direct result of a decline in provider reimbursements, but most institutions are losing money nonetheless. If it's not the charity cases they just have to take on because of a certain demographic, it's the incessant denial of reimbursement from private insurance companies based on some "medical manager's" decision that the patient with "chest pain" wasn't drying from acute coronary syndrome, he just had costochondritis and thus could have been treated as an outpatient! Admissions denied! Payment for services denied!

And there's a nusance with Ambulatory Surgery Centers (ASCs) that I don't quite understand insofar as reimbursement for the facility fee is concerned. I heard that ASCs can't collect a facility fee for certain operations unless they were physically connected to an acute care receiving hospital in some way. Is that true? What are these operations that can't be performed in an ASC? What about an in-office "operatory?"

Healthcare would be so much simpler if it wasn't for insurance companies. Fee for service, like the Baby Boomers had it and f_cked with until it was dry and raw, was awesome.

The AMA is biggest cartel in the U.S. This is obvious to everyone except the AMA.

Castro Viejo said:

Yes, hospitals aren't losing money as a direct result of a decline in provider reimbursements, but most institutions are losing money nonetheless. If it's not the charity cases they just have to take on because of a certain demographic, it's the incessant denial of reimbursement from private insurance companies based on some "medical manager's" decision that the patient with "chest pain" wasn't drying from acute coronary syndrome, he just had costochondritis and thus could have been treated as an outpatient! Admissions denied! Payment for services denied!

And there's a nusance with Ambulatory Surgery Centers (ASCs) that I don't quite understand insofar as reimbursement for the facility fee is concerned. I heard that ASCs can't collect a facility fee for certain operations unless they were physically connected to an acute care receiving hospital in some way. Is that true? What are these operations that can't be performed in an ASC? What about an in-office "operatory?"

Healthcare would be so much simpler if it wasn't for insurance companies. Fee for service, like the Baby Boomers had it and f_cked with until it was dry and raw, was awesome.

Click to expand...

In some cases where you are highly likely to end up admitting someone for a procedure (e.g. lap cholecystectomy has a high chance of staying as an inpatient for multiple reasons) then I can see insurance's denying you coverage for doing a procedure in an ASC because they dont want to pay the price of an ER visit if later you decide the patient needs to be admitted. For cases with low admission rate postoperatively (e.g. septal mucusectomy or Transanal Excison) then you can convince the insurance that you will direct admit them.. or even go physically get hospital privilages by operating part time in a hospital and basically claim you are admitting to that hospital from the ASC.... hence some ASC are built very near hospitals or even on certain hospital floors (and later they become regular operating rooms as the hospital expands and eats them).

Castro Viejo said:

And there's a nusance with Ambulatory Surgery Centers (ASCs) that I don't quite understand insofar as reimbursement for the facility fee is concerned. I heard that ASCs can't collect a facility fee for certain operations unless they were physically connected to an acute care receiving hospital in some way. Is that true? What are these operations that can't be performed in an ASC? What about an in-office "operatory?"

Click to expand...

I am not aware of the physical connection rule. I have scrubbed in tons of surgicenters miles away from hospitals. All of the cases that you would actually want to do can be done in a surgicenter.

Most states require that you have admitting privileges in a hospital in order to do outpatient surgery at an ASC. This is where the hospital can get you. To get privs at a hospital they will likely require you to take call. Hospitals have gotten wise to the whole "I only do outpatient surgeries so I only need courtesy privs" argument. Most hospitals will require you to take ER call even for courtesy privs now because so many surgeons were saying to hell with it I'll just do outpatient procedures. I haven't found a great solution to that problem yet. One way out for me is to just find a closeby small town that wants the facilities fees for my few insurance cases. I already have privs in 3 hospitals like that. The problem is that if I do surgery in an ASC and I actually need to admit someone or take them back to the OR they would have to drive about 20 minutes to a small town in the middle of nowhere. I've thought about hiring a limo service for those occasions but I don't know if I like it. I might get stuck taking ER call for plastics in a local hospital. I just need to figure out which one has the most benign call and the best patient demographics. That being said any unpaid bills by dirtbags will go to a collections agency. Daddy needs a new pair of shoes so he doesn't work for free.

You can have an office OR if you want. I am building one into my office. If you live in a certificate of need state you can't collect the facility fee from insurance or medicare though. If you have cash paying patients then an office OR might make sense for you.

There's going to be a constantly changing of set of arbitrary "rules" making it more difficult for surgeons to set up ACSs. The weak excuse of "conflict of interest" and doctor's "overtreating patients" is going to be the lame excuse, but of course we all know the real reason is that revenue being diverted from hospitals to the doctors/investors who set up ACSs that provide a superior service isn't going to sit well.

Read some of the regulations being enforced. It's being made as difficult as possible to start an ACS & turn a profit.
http://www.kutakrock.com/publications/healthcare/Ambulatory_Surgery_Center_Joint_Ventures.pdf

1. Physicians who don't operate in the ACS cannot invest in it.

? So along those lines, someone who owns a tow truck company can't send a client to a body shop that he is part owner of unless the tow truck owner is there putting on new fenders ?

2. If the physician retires or relocates, he can no longer be invested in the ACS.

? So, if I open a restaurant, then relocate to another town to open another restaurant, I have to sell my 1st restaurant ?

3. Stark Laws - If one finds a need for the creation of a certain new product or service (ex non-fogging laparoscopes or physical therapy service), s/he is not allowed to refer their patients to an entity that provides that service if they have a financial interest in that facility

? I own a home construction company. I see a need for excavation services in the area, so I invest in an excavation company. I am not allowed to refer clients using me to build a home to the excavation company ?


This is getting ridiculous.

PrecordialThump said:

There's going to be a constantly changing of set of arbitrary "rules" making it more difficult for surgeons to set up ACSs. The weak excuse of "conflict of interest" and doctor's "overtreating patients" is going to be the lame excuse, but of course we all know the real reason is that revenue being diverted from hospitals to the doctors/investors who set up ACSs that provide a superior service isn't going to sit well.

Read some of the regulations being enforced. It's being made as difficult as possible to start an ACS & turn a profit.
http://www.kutakrock.com/publications/healthcare/Ambulatory_Surgery_Center_Joint_Ventures.pdf

1. Physicians who don't operate in the ACS cannot invest in it.

? So along those lines, someone who owns a tow truck company can't send a client to a body shop that he is part owner of unless the tow truck owner is there putting on new fenders ?

2. If the physician retires or relocates, he can no longer be invested in the ACS.

? So, if I open a restaurant, then relocate to another town to open another restaurant, I have to sell my 1st restaurant ?

3. Stark Laws - If one finds a need for the creation of a certain new product or service (ex non-fogging laparoscopes or physical therapy service), s/he is not allowed to refer their patients to an entity that provides that service if they have a financial interest in that facility

? I own a home construction company. I see a need for excavation services in the area, so I invest in an excavation company. I am not allowed to refer clients using me to build a home to the excavation company ?


This is getting ridiculous.

Click to expand...

These rules remind me of the rules that wouldn't let Hank Reardon own his own mines, even though all the other mine owners were louses and couldn't get ore to him on time. Read Atlas Shrugged.

Here is something I don't get. If the hospitals buy up physician practices, thus becoming the owners, how is it not a violation of self referral laws and Stark laws if those physicians use the hospital for inpatient services?

All of these laws are designed to wrestle power away from physicians and force you to work for less than you are worth. In the end the physicians have the power to walk away. Physicians are not replaceable labor so really the power is in your hands. On top of making rules like these, the medical schools are teaching all of you figheads that it is wrong to think of your own self interest when it comes to the practice of medicine. Read some of these threads on here, seriously people. There are figs who think that working twice as hard and long as the average person isn't enough, and that anyone who doesn't want to work 120 hours a week for 40K a year is weak. Figs people. Figs.

I am startingmedical school in August and posts like this are making me freak out. I will be graduating with 250k in debt and I'm starting to worry that I won't be able to pay it back with the salaries and the problems you are talking about.
Isn't it time for doctors to unite against HMOs, Walmart and the rest who are trying to rip them off?

We have to work our butts off to get into medical school, then study like crazy for four years, slave for 5 or 6 more years for this?
I don't mean to say that doctors should be millionaires but either should medical education be subsidized or doctors should be able to pay their debts off while keeping a decent living!

M.Furfur said:

I am startingmedical school in August and posts like this are making me freak out. I will be graduating with 250k in debt and I'm starting to worry that I won't be able to pay it back with the salaries and the problems you are talking about.
Isn't it time for doctors to unite against HMOs, Walmart and the rest who are trying to rip them off?

We have to work our butts off to get into medical school, then study like crazy for four years, slave for 5 or 6 more years for this?
I don't mean to say that doctors should be millionaires but either should medical education be subsidized or doctors should be able to pay their debts off while keeping a decent living!

Click to expand...

I agree with you.

John Q. Public wants to know, however, what's "decent" for you, doctor?

The issue is quite complex and will likely only begin to be reformed in your lifetime as a physician. I doubt you'll see huge changes in the way you're reimbursed during your career. I think the system will just stay the way it is until it just totally blows up in everyone's face and destroys the economy. At that point, hopefully you've made enough to retire comfortably to some island somewhere and practice surgery on sea turtles.

M.Furfur said:

I am startingmedical school in August and posts like this are making me freak out. I will be graduating with 250k in debt and I'm starting to worry that I won't be able to pay it back with the salaries and the problems you are talking about.
Isn't it time for doctors to unite against HMOs, Walmart and the rest who are trying to rip them off?

We have to work our butts off to get into medical school, then study like crazy for four years, slave for 5 or 6 more years for this?
I don't mean to say that doctors should be millionaires but either should medical education be subsidized or doctors should be able to pay their debts off while keeping a decent living!

Click to expand...

As far as hospitals are concerned... you dont have to anything.. as long as you are board certified surgeon.... They dont care if it is 1 year or 10 years. The amount of self hindrence to get to the end point is self inflicted by older physicians. In some cases it is rightly so and in others (like oral boards following written boards for certification) is self inflicted.

GSresident said:

Here is something I don't get. If the hospitals buy up physician practices, thus becoming the owners, how is it not a violation of self referral laws and Stark laws if those physicians use the hospital for inpatient services?

Click to expand...

Stark rules don't apply to employees, only to the relationships between private docs and hospitals.

By the way, I read an article the other day where Ol' "Pete" Stark was interviewed and he said he regrets ever getting his eponymous law passed, now that the true effect on medicine has been borne out.

Thanks a lot for that now, Pete.

This is, in a word, terrifying. On the one hand, if you were to ask anyone whose opinion I respect who they think the most well-trained, complete "doctor" in a hospital is, they would say the General Surgeon no questions asked. This in itself is one of the main reasons a gal like me is still keeping GSU on the differential and one of the main reasons (I assume) that folks like GSRes and Castro haven't jumped off a cliff already. But when you read stuff like this, suddenly bone-fixing for a living doesn't look so bad in comparison, even if that's going in the toilet too.

So, Castro et. al. what do you say to someone like me? Do it anyway and love it because you can? Start working on my benchpress and pick up a drill? Get an MBA, join the dark side, and saddle up with Big Pharma?

GSresident said:

These rules remind me of the rules that wouldn't let Hank Reardon own his own mines, even though all the other mine owners were louses and couldn't get ore to him on time. Read Atlas Shrugged.

Click to expand...

!!!

Or, for something less well-written and more medically related, pick up "Noble Vision" by Gen La Greca.

pagemmapants said:

So, Castro et. al. what do you say to someone like me? Do it anyway and love it because you can? Start working on my benchpress and pick up a drill? Get an MBA, join the dark side, and saddle up with Big Pharma?

Click to expand...

Unfortunately no one can predict the future. If you asked Radiologists just five years ago how they viewed the future of their specialty? They'd say " I gotta wear shades." Then BAM! Nearly a 25% reduction in their RVUs. Translation: their reimbursements go down, utilization of radiological services has to fall in line according to CMS. Gas passers? 25% increase in their RVUs. Go figure.

Surgery (General and the subspecialties)? 1% reduction annually for the last several years.

Preventive/Primary care services have seen a 1-3% increase in their RVUs. So what?

I don't know where this is going to land 10-15 years from now when you'll be in the throes of junior attending practice (that is, of course, unless you plan to spend your "decade with Dave"). For now I'd say just to do what you believe you'd enjoy, see what the future holds, but make concessions to possibly bail if you don't think it's living up to your standards. That would be the same thing I'd suggest whether you went into General Surgery, Orthopedics, Plastics, Anesthesia, Radiology, or anything else.

Oh, and study for the GMAT. I did.

I'd also further discourage you from voting a Democrat into office. They'll just screw with your livelihood more than any Republican would.

gudog said:

Stark rules don't apply to employees, only to the relationships between private docs and hospitals.

By the way, I read an article the other day where Ol' "Pete" Stark was interviewed and he said he regrets ever getting his eponymous law passed, now that the true effect on medicine has been borne out.

Thanks a lot for that now, Pete.

Click to expand...

If this is the case, what is to prevent me from founding a corporation to build a surgicenter and making myself an employee of that corporation? Wouldn't that be the same thing as becoming the employee of a hospital? I am an employee of my own corporation right now. I'm probably going to start another one when I actually start to buy equipment or upgrade by buying instead of renting an office. My practice corporation "rents" the space and equipment from my Equipment corporation. That way the practice doesn't have any real assets and can't be sued for assets. Thank you Plastic Surgery News.

Castro Viejo said:

... At that point, hopefully you've made enough to retire comfortably to some island somewhere and practice surgery on sea turtles.

Click to expand...

That's win-win. Sea turtles are cool and they don't sue. Plus if all else fails, you have the makings of a really great soup (if iron chef is to be believed)

GSresident said:

If this is the case, what is to prevent me from founding a corporation to build a surgicenter and making myself an employee of that corporation? Wouldn't that be the same thing as becoming the employee of a hospital? I am an employee of my own corporation right now. I'm probably going to start another one when I actually start to buy equipment or upgrade by buying instead of renting an office. My practice corporation "rents" the space and equipment from my Equipment corporation. That way the practice doesn't have any real assets and can't be sued for assets. Thank you Plastic Surgery News.

Click to expand...

To my knowledge, there is no self referral problem with using a facility that you own, ie, your office. The Stark laws govern financial entanglements between docs and facilities that want their business, but where the docs are independent entities.

Kubed said:

That's win-win. Sea turtles are cool and they don't sue. Plus if all else fails, you have the makings of a really great soup (if iron chef is to be believed)

Click to expand...

And the shell would turn into an awesome chair or table or something...

Speaking of sea turtle surgery...
http://publicaffairs.uth.tmc.edu/media/newsreleases/nr2008/maxillofacial.htm

abcess said:

Speaking of sea turtle surgery...
http://publicaffairs.uth.tmc.edu/media/newsreleases/nr2008/maxillofacial.htm

Click to expand...

Thank you for that present! Just sent an email to my buddy in dental school asking what year they learn to work on turtles